Traumatic brain injury (TBI) frequently results in functional morbidity in children, including multiple neurobehavioral deficits. The proposed research will be integrated into a newly initiated study investigating the utility of various neuroimaging methods in understanding the effects of focal and diffuse injuries on recovery of cognitive and neurobehavioral outcomes following pediatric TBI. Moderate to severe TBI patients (n=30) and matched healthy controls (n=30) will participate in neuroimaging studies, neuropsychological tests, and structured interviews and questionnaires. Participants will undergo longitudinal assessments, conducted post-acutely (3-8 weeks post injury) and at 12 months post injury, and approximately 10-12 months apart for healthy controls. The proposed research will add acute (1-15 days post injury) Magnetic Resonance Spectroscopy (MRS) to the existing neuroimaging protocol. MRS metabolites (N-acetyl aspartate, myoinositol, and glutamate/glutamine ratios with creatine and choline) will be used to predict neuropsychological outcome and recovery following injury. The neuropsychological domains will focus on skills sensitive to TBI: executive functions, secondary memory, and interhemispheric functioning. MRS metabolites will be measured from brain regions associated with the neuropsychological domains of interest. We will compare metabolite levels between TBI patients and healthy controls, controlling for age at injury and injury severity. The specific hypotheses addressed in this study expand on my doctoral dissertation's findings, address some of its limitations, and capitalize on the longitudinal design of the existing study to further determine the extent to which acute measurements of brain metabolites predict neuropsychological functioning and recovery after a traumatic brain injury in childhood. [unreadable] [unreadable] [unreadable]